-
Categories
-
Pharmaceutical Intermediates
-
Active Pharmaceutical Ingredients
-
Food Additives
- Industrial Coatings
- Agrochemicals
- Dyes and Pigments
- Surfactant
- Flavors and Fragrances
- Chemical Reagents
- Catalyst and Auxiliary
- Natural Products
- Inorganic Chemistry
-
Organic Chemistry
-
Biochemical Engineering
- Analytical Chemistry
-
Cosmetic Ingredient
- Water Treatment Chemical
-
Pharmaceutical Intermediates
Promotion
ECHEMI Mall
Wholesale
Weekly Price
Exhibition
News
-
Trade Service
*For medical professionals only
See which regimen your patients need to use?
Guide
Patients with diabetes combined with new coronary pneumonia in different situations need insulin therapy, specifically in the following 7 situations:
● Mild to moderate increase in blood sugar (due to the lack of appetite of new crown pneumonia patients, it is recommended to use the "three short and one long" basic + mealtime insulin regimen to reduce glucose
.
Commonly used basal insulin is Degludec insulin, etc.
);
● Complicated by diabetic ketoacidosis and hyperglycemic hyperosmolar state;
● Complicated by lactic acidosis;
● Acute respiratory distress syndrome aggravated by elevated blood glucose;
● Abnormal liver and kidney function;
● Glucocorticoids aggravate hyperglycemia;
● Enteral (external) nutrition leads to increased
blood sugar.
The condition of patients with diabetes combined with new coronary pneumonia may worsen at any time, resulting in acute complications of diabetes, occasionally combined with gastrointestinal symptoms, liver and kidney function damage, hormone therapy and other special conditions
.
Therefore, oral hypoglycemic drugs with relevant effects should be avoided in the selection of hypoglycemic drugs
.
Insulin has the advantages
of no gastrointestinal adverse reactions, obvious hypoglycemic effect, conducive to tissue repair, timely and flexible adjustment of dose, and no contraindications to liver and kidney function.
This article will sort out the insulin treatment regimens
for patients with diabetes and new coronary pneumonia in 7 different situations.
First, mild to moderate increase in blood sugar Even if the majority of new coronary pneumonia patients are mild and common, but the condition can progress rapidly when the immunity is low, and the secretion of stress hormones in infected patients increases, insulin resistance worsens, which can make blood sugar significantly rise, and poor blood sugar control can lead to further aggravation of infection, so insulin must be used to control blood sugar flexibly and quickly, and the dose of insulin increases by about 10% ~ 30% compared with the previous one
。 Due to the lack of appetite of patients with new coronary pneumonia, the use of "three short and one long" basic + mealtime insulin regimen is advocated to reduce glucose [1].
Among them, the commonly used basal insulin is insulin de gludec [2].
At the same time, the amount of
insulin is adjusted according to the patient's glycemic control.
Second, complicated by diabetic ketoacidosis and hyperglycemic hyperosmolar
state infection are the most common causes of diabetic ketoacidosis, accounting for 50%.
Combined age, dehydration, and hormonal use can lead to hyperglycemic hyperosmolar states
.
Intravenous stepwise control of blood glucose with low-dose insulin must be used to prevent cerebral oedema, along with fluid replacement, especially in hyperosmolar states, and alkali
if necessary.
The insulin regimen of patients with diabetes complicated by diabetic ketoacidosis and hyperglycemic hyperosmolar state and diabetes combined with new coronary pneumonia is as follows[1]:
Third, complicated by lactic acidosis, hyperglycemia, infection, hypoxia, and dehydration are common causes of lactic acidosis
。 In the later stage of novel coronavirus pneumonia, lung function may be reduced, dyspnea can occur, and the body uses anaerobic digestion metabolism capacity after hypoxia, and acidic metabolites increase, which is easy to be complicated by lactic acidosis
.
Treatment requires removal of triggers, restoration of tissue perfusion and oxygen supply, reduction of lactic acid production, and promotion of diuretic acid
excretion.
Hypoglycemic regimen should choose insulin and glucose in combination, intravenous glucose + insulin in a certain proportion (3~5:1) rehydration, reduce sugar anaerobic digestion, conducive to the removal of blood lactic acid, if necessary, hemodialysis treatment [1].
。 Fourth, acute respiratory distress syndrome aggravates blood glucose rise Severe patients with novel coronavirus infection may have acute respiratory distress syndrome, and its refractory hypoxemia and systemic inflammation lead to further hypoxic necrosis of pancreatic islet β cells; Hypoxic damage of the kidneys and extensive thrombosis and fibrin deposition lead to blockage of blood vessels and damage to microcirculatory structures, preventing glucose from being excreted; Respiratory failure can aggravate hyperglycemia
in patients with mitochondrial energy metabolism and glucose utilization disorders.
The above conditions cause blood sugar to rise further, and it is necessary to use insulin to control blood sugar as soon as possible to achieve relaxed indicators [1].
5.
Liver biopsy specimens of patients with abnormal liver and kidney function of novel coronavirus pneumonia showed moderate steatosis and mild hepatic lobular and portal vein activity, and renal biopsy showed tubular epithelial degeneration and shedding, microthrombus and focal fibrosis, combined with renal failure
.
It suggests that patients have a high possibility of liver and kidney function damage, oral hypoglycemic drugs can increase the burden on organs, so it is advisable to use fast-acting or short-acting insulin to reduce glucose, and use medium- and long-acting insulin with caution to avoid the occurrence of hypoglycemia [1].
6.
In the treatment of glucocorticoids aggravating hyperglycemia, most critically ill patients use glucocorticoids to play an anti-inflammatory, antiviral and immunosuppressive role
.
However, exogenous use of glucocorticoids can cause hyperglycemia for the following three reasons [1]:
1.
Glucocorticoids can promote hepatic gluconeogenesis and glycogen separation, increase hepatic glucose output, and reduce skeletal muscle and Glucose utilization and insulin sensitivity of adipose tissue
.
2.
Glucocorticoids directly act on pancreatic islet β cells, impairing
their function.
3.
Glucocorticoids stimulate plasma insulin secretion by affecting phosphatidylinositol and lysophosphatidylinositol, activating G protein-coupled receptor 55, resulting in hyperisinemia and hyperglycemia
。
As a first-line agent, insulin should be given the smallest effective dose possible, and basal insulin deficiency can be supplemented with long-acting insulin
.
Steroids are accompanied by short-acting intravenous human insulin infusions or insulin pump pumps to lower blood glucose, and the amount of insulin is adjusted according to blood glucose conditions to avoid elevated blood glucose due to hormonal use [1].
7.
Enteral (external) nutrition leads to increased blood sugar, diabetes mellitus combined with severe and critical new coronary pneumonia patients can not eat, need nasogastric feeding, enteral nutrition and intravenous infusion of parenteral nutrition, intravenous infusion ratio of glucose to insulin ratio of 2~4:1; and nasal feeding requires subcutaneous injection of fast-acting or short-acting insulin during meals to control blood sugar [1]
。 Commonly used rapid-acting insulin analogues include insulin aspart [2].
References:
[1] XIONG Qing, XU Yancheng.Insulin therapy in patients with diabetes mellitus and novel coronavirus pneumonia[J].
Journal of Clinical Internal Medicine.
2021,38(8):518-521 [2] Expert consensus on short-term intensive insulin therapy for type 2 diabetes mellitus (2021 edition)[J].
Chinese Journal of Diabetes.
2022,14(1):21-31
The web version of the doctor's station is online
Please scan the QR code below or click to read the original article, you can browse more endocrine frontier information without downloading
The source of this article Sugar Medical Network Responsible EditorOrange
Call for Papers The Medical Endocrinology Channel welcomes your submissions! Click the link below or scan the QR code to submit: https://titan.
yishengzhan.
cn/#/public_contribution Please fill in the real information according to the call page*"The medical community" strives to publish the content professional and reliable, but does not promise the accuracy of the content; Relevant parties are requested to check
separately when adopting or using it as a basis for decision-making.
